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24A-012 (4) BP-2023-0845 110 PROSPECT AVE COMMONWEALTH OF M SSACHUSETTS Map:Block:Lot: 24A-012-001 CITY OF NORTHA PTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGI TERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARA TY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-0845 PERMISSIO IS HEREBY GRANTED TO: Project# WINDOW 2023 Contractor: License: Est. Cost: 1274 LOWES HOME CE ERS INC 117055 Const.Class: Exp.Date: 08/02/202 Use Group: Owner: B KOR A NATHAN S&JENNIFER Lot Size (sq.ft.) Zoning: URB Applicant: LOWE HOME CENTERS INC Applicant Address Phone: Insurance: 282 RUSSELL ST (413)588-0270 WA565D294595013 (AOS) HADLEY, MA 01035 ISSUED ON: 06/26/2023 TO PERFORM THE FOLLOWING WORK: REPLACEMENT BASEMENT WINDOW POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NO HAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: ' ' . • f , ,2 , '/ • . . Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax (413)587-1272 Office of the Building Commiss ner se i-: c �, o °a The Commonwealth of Massachusetts .6 d Board of Building Regulations and Standards MUNICIPALITYOR F v Uc`' _' Massachusetts State Building Code, 780 CMR USE =Build fig Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 z One-or Two-Family Dwelling - -- 2 Th's Section For Official Use Only -t w Buildidg Per it Number a) 3 v/� Date lied: -__ ii-I ,Kass 6- ZG zoZ3 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 ProFe�t}�dr�����i 1.2 Assessors Map&Parcel Numbers 1.1a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimes ions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' i 2.1 Owner �rjC�DV a) i f d g/r /—`r p O/o(iO Name nut) City State,ZIP No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(skie Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other, 0 Specify: Brief Description of Proposed W�����:1,"1 eivrealigLiL.1 ji(se SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ pig i ts/ 1. Building Permit Fee:$ Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $ 0 Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All F Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ /d 79,ij) ❑Paid in Full ❑Outstanding Balance Due: / )/( 4 5 , �ea o, ('19-)-7 SECTION 5: CONSTRUCTION SERVICES 5.1 Constru ' Supervisor License CSL) /, , / /10 � ' je f�� �y(,C� License/Numbler Exp ti Date Name of CSL Holder., J_//(/` 4 'z&5 /�y i( , List CSL Te(see below)No.and t /` (/�(j,��/� /tv� Type Description / b &T D/„ ANI— U Unrestricted(Buildings up to 35,000 cu.ft.) ��/ iP �/` (/// R Restricted 1&2 Family Dwelling City/Town,State, M Masonry RC Roofing Covering WS Window and Siding 043) %/7,ifseJD hp /eloGorwAa r_ivi3Or F Solid Fuel Burning Appliances ✓�U/ C G,j.�.A Insulation Telephone 'mail address Demolition 5.2 Registere Home Improvement Contras t(HIC) HR O Ga /Oh lie � «6'od HIC Registration Number Exl>�tration Date HIC Com Na or C e ' t N�tte No.and t 91S —��s-- Email address Gores✓//te we //7 D/ City/Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes No 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR UILDING PERMIT 1,as Owner of the subject property,hereby authorize --AretifdPJ to act on my behalf,in all matters relative to work authorized by this building it application. tt2, )eiya - /..erx„$/te7-- /Gr-of/Ne__ Pri n Came Electronic Signature) Date I ( Z;n ) SECTION 7b:OWNER' OR AUTHORIZED AGENT)ECLARATION By entering my name below,I hereby attest under the pains and penalties of that all of the information contained in this application is e and accurate to the best of my knowledge an understanding. 4' �� / Print Owner's or uthorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed_, Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" City of Northampton fe� t w Massachusetts i�� 1_ '<< It _� At DEPARTMENT OF BUILDING INSPECTIONS ���' ` 212 Main Street • Municipal Building yJH s� �� Northampton, MA 01060 "'kJ, �`^�� CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: 60-eti-P/66 J7��) Location of Facility. � Pul P� /4K Zz -- t) ,X5 , crV0.2_, The debris will be transported by: Name of Hauler: (--1a) )- -.9Q✓1\ c di----) 1 Signature of Applicant: ) )4/// Date: "1 The Contmenrt.euith of Massachusetts -"~b Deportment of Industrial Accidents Li I Congress Street.Suite 100 Boston. MA 02114-2017 cis .._,_,.r.0 www.mass.gor/dia Vs ut kers'Compensation Insurance Alfidav it: Builders/C ors/Eketriciaold-Plumbers. 1'O BE FILED N'nit THE rERNII I'I'I%G tITHOW tl. Applicant Information Please Prins l.roiillt Name If3ttainess:Orgamzatton Indies''dual►: LOWES HOME CENTERS Address: 1000 LOWES BLVD CitylStatelZip: MOORESVILLE, NC 28117 phone#: 860-505-9314 Are yun an employer"t beck the appropriate tact: Type of project(required). l.Q I aril a.ulpl.lva anti employees(tall and or part-time I.* 7. 0 New construction 20 I am a sole propnetut or partnership and have no etttpliiyers a'Ante tut nu:in K.Q Remodeling any ts-tpalaty.[Nu workers'comp.=mance rcquirtd.l 9. ©Demolition .3lj I am a hucraxraner doing all work myself.[Nu works.'rump.strew ance tt urrol.1' I0 Q Building addition 4.®I an.a hurtava ma and.ill he homy sme arn.1uts to uundtui all ands on my property. I will aware that all contracture either hate workers"ouinpnuation unuranx m an sue 110 Electrical repairs or additions pluprt. or;with no ernpluvcu. 12.0 Plumbing repairs or additions Sal I am a bax1al contractor and 1 Kati c hind the sob-euotna1um listed no the attached shiest. 13.0 Roof I hex sub-cunuxton bate employers and hate workers'comp.insurance.: repairs ba We are a eue in puratir and rb officers have eaa'iaed their right of cxertipprua per hark c. I4_(Mather 152.¢I(4) and ae have no mnpluyx:et,.[No*utters'comp.insurance ter/net:: l 'Any applaant that checks but rc I must also fill uui die!edam below show use then workers':utrrpccuatiun pokey tnlonnntura. t Honeoa rays who submit this affiditrt indicatinu dury are doing all atilt and then hue outside:untracterrs mint:about a new atfrdai If indaatine such :Contractors that clack this karts mist atlas tied an additional drier show tog the name ut the sus.-contract's and stale a h.-thcr to nut thud entittc,hale 17lrlu;4ees It the sub-e nitracturs hart cirgrtuyee..the}must pros ids thcir warier. ttlnp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: LM INSURANCE CORP _ Policy#or Self-ins.Lie.#: �WA565Q294595013(AOS) Expiration Date: 4/2/2024h� Job Site Address: I/O r )nOS 2/ J ,7Qj City;5tatt2ipL I/�//r 1//�� i 4 AAttach a copy of the workers'compensation poke,' declaration page(showing the policy number and expiration date). 01/./j(J Failure to secure coverage as required under MGL c. 152,*25A is a criminal iolalit n punishable by a fine up to S1.500.00 anci•'ur one-year imprisonment,as well as civil penalties in the form of a STO WORK ORDER and a fine of up to S250.00 a day against the violator.A copy of this statement may be forwarded to the of Inn esttgatlons of the DIA for insurance coserat,e verification. 1 do hereby certify under the pains a that and penalties of perjury at the information provided abo,v'eis true and correct Signature: N¢�te: Sete Date. 670(1/-79/V;IS Phone 4: 860-505-9314 Official use only. Du flirt write in this urea.to he completed by city or town officiat city or Town: Permitil.icense 02 __ Issuing Authority(circle one): I. Board of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector O.Other Contact Person: Phone#: THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washingtgo. , - Suite 710 Boston, Massachusetts 02118 Home Improvement C' ifttractor Registration f Type- Supplement Card LOWE'S HOME CENTERS. LLC 1.tt `� 5.r Registration: 148688 1000 LOWES BLVD Expiration: 1017,2023 SERVICES COMPLIANCE MOORESVILLE,NC 28117 - f • ak -r Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE:Supplement Card Office of Consumer Affairs and Business Regulation Registration Expiration 1000 Washington Street -Suite 719 148688 10117/2023 Boston,MA 02118 LOWE'S HOME CENTERS,LLC NEXEDES SOTO 1000 LOWES BLVD r;M' 1 /�4 t 1 SERVICES COMPLIANCE MOORESVILLE.NC 28117 Undersecretary Not valid without signature AORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 06/16/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Nancy Lewis NAME: Abbate Insurance Associates,Inc. tPHOONN,Ext). (203)777-7229 FAX No): (203)865-7593 671 State Street ADDRESS: nlewis@abbateins.com INSURER(S)AFFORDING COVERAGE NAIC tt New Haven CT 06511 INSURER A: Acadia Insurance Company INSURED INSURER B: East Coast Millwork,LLC INSURER C: 14R Peach Orchard Rd. INSURER D INSURER E: Prospect CT 06712 INSURER F: COVERAGES CERTIFICATE NUMBER: 23-24 All lines REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED- NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR TYPE OF INSURANCE ADDL-SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MM/DDIYYYY) (MM/DDIYYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 XI DAMAGE I O REMED 500,000 CLAIMS-MADE ' l OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 15,000 A CPA5549377-10 06/04/2023 06/04/2024 PERSONAL AADVINJURY $ 1,000,000 GEM_AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2.000,000 PRO- 2,000,000 POLICY JECT LOC PRODUCTS-COMP/OP AGG $ OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED CAA5549378-10 06/04/2023 06/04/2024 BODILY INJURY(Per accident) $ _ AUTOS ONLY _ AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ _ AUTOS ONLY AUTOS ONLY (Per accident) $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000 A ^ EXCESS LIAB CLAIMS-MADECUA5549379-10 06/04/2023 06/04/2024 AGGREGATE $ 3,000,000 DED l RETENTION$ $ WORKERS COMPENSATION NA PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER v/N 500000 A ANY PROPRIETOR/PARTNER/EXECUTIVE Y NIA WCA5549380-10 06/04/2023 06/04/2024 E.L.EACH ACCIDENT $ , OFFICER/MEMBER EXCLUDED (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Vendor 11878 Region 18 The General Liability And Auto Liability policy include Lowe's Companies,Inca nd Lowe's Home Centers,LLC as additional Insureds as required by written contract. This insurance is primary and non-contributory over any other available insurance coverage. 10 Day notice of cancellation for non-payment of premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Lowe's Companies,Inc.and any and all subsidiaries ACCORDANCE WITH THE POLICY PROVISIONS. 1000 Lowe's Blvd. AUTHORIZED REPRESENTATIVE Mooresville NC 28117 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Commonwealth of Massachu- etts illHf Dtviston of Occupational Lice sure -- Board of ButIding Regulations and Standards 4 C 0 riStittitital7 1 ISUPeAli 1 r CS-117055 ....: r:fic 0 ires: 08/0212025 ,... ,..A KYLE R SEARLES .- :0 1 14R PEACH ORCHARD ROAD PROSPECT CT 06712 ,-,..- .. .. ,, •?./.4 .„.:\ 1.,.., . Commissioner : ar fi 0(741,0..t,k CORE, CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 03/17/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Marsh USA Inc. NAME: 100 North Tryon Street Suite 3600 (ac No,Ext.): (A/C,No): Charlotte,NC 28202 EMAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC• CN102776519-Loaves-SI-23-24 Y INSURER A:Liberty Mutual Fire Insurance Company 23035 INSUREDLowe's companies,Inc. INSURER B:Interstate Fire&Casualty CO 22829 and stlbsldaries INSURER C:LM Insurance Corporation 33600 1000 Lowe's Bouevard INSURER D: Mooresville,NC 28117 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: ATL-004934190-29 REVISION NUMBER: 27 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POUCY EFF POUCY EXP LTR TYPE OF INSURANCE RINDS SWV BDR POLICY NUMBER (MMIDDY/YYTY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE TO RENTED $ CLAIMS-MADE OCCUR Self Insured-See below PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AS26512'34595103 04/01/2023 04/01/2024 COMBINED SINGLE LIMIT $ 5,000,000 A AUTOMOBILE LIABILITY (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ — OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY _ AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ _ AUTOS ONLY _ AUTOS ONLY (Per accident) B X UMBRELLA LIAB X OCCUR USZ000210200 04/01/2023 04/012024 EACH OCCURRENCE $ 10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000,000 DED RETENTION$ $ C WORKERS COMPENSATION WA565D294595013(AOS) 04/01/2023 04/012024 X PER ETH- AND EMPLOYERS'LIABILITY STATUTE ER C Y/N WC5651294595023(WI,MN) 04/01/'523 04/01/2024 E.L.EACH ACCIDENT $ 2,000,000 ANYPROPRI ETOR/PARTN ERIEXECUTNE OFFICER/MEMBER EXCLUDED? N IA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 2.000,000 IT yes,describe under 2,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C Excess Workers'Compensation EW565N294595063(FL) 04/01/2023 04/01/2024 (WC per statute) 3,000,000 A Excess Workers'Compensation EW265N294595033(AOS) 04/01/2023 04/01/2024 (WC per statute) 3,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Commercial General Liability policy is Self-Insured,effective 4/12023 to 4/12024. SEE SECOND PAGE FOR ADDITIONAL WORDING CERTIFICATE HOLDER CANCELLATION Lowe's Companies,Inc. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE and its subsidiaries THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1000 Loaves Boulevard ACCORDANCE WITH THE POLICY PROVISIONS. Mooresville,NC 28117 AUTHORIZED REPRESENTATIVE i :Z ect,w ?ISr� 7yc. ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD • AGENCY CUSTOMER ID: CN102776519 LOC#: Charlotte A`ORO ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Marsh USA Inc. Lowe's Companies,Inc and subsidiaries POLICY NUMBER 1000 Lowe's Boulevard Mooresville,NC 28117 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance EXCESS WORKERS COMPENSATION(MO) Carrier:Liberty Mutual Fire Insurance Co. Pdicy Number EW265N294595053 Effective/Expiration dates:04/0112023-04/0112024 Linit(Per Statute):$3,000,000 EXCESS WORKERS COMPENSATION(MA) Carver:Liberty Mutual Fire Insurance Co. Pdicy Number:EW265N294595043 Effective/Expiration dates:04/01/2023-04/012024 Limit(Per Statute):$3,000,000 Workers'Compensation and Excess Workers'Compensation pdides indude a self-insured retention of$2,000,000. General Liability The insured is self insured for$10,000,000 each occurrence for the period of 4/1/2023 to 4/1/2024. The Automobile Liability pdicy evidenced above is subject to additional self-insured retentions excess of limits shown for various perils covered. Regarding Auto Liability and Umbrella Liabiity: Any party with which the Named Insured has a contractual agreement to indude as additional insured is included as such under the pdides if required by written contract with the named insured subject to the pdicy terms and conditions_Coverage under the pdides only applies to the extent of the coverage required by such contractual requirement and for the limits specified in such contractual requirement,but in no event for coverage not afforded by the pdicies nor for limits in excess of the applicable limit of the pdicies. Insured is self-insured for Automobile Physical Damage for the period of 4/1/2023 to 4/12024. Regarding Workers Compensation,Excess Workers Compensation,and Umbrella Liabiity: Any party with which the named insured has a contractual agreement to provide Waiver of Subrogation is included as such under the pdicies if required by written contract with the named insured,subject to the pdicy terms and conditions.Coverage under the pdicies only applies to the extent of the coverage required by such contractual requirement and for the limits specified in such contractual requirement,but in no event for coverage not afforded by the pdicies nor for limits in excess of the applicable limit of the pdicies. Additional Information: The Named Insured includes Lowe's Companies,Inc.and its subsidiaries,including but not limited to Lowe's Home Centers,LLC,Orchard Supply Company,LLC,Allied Trade Group LLC,and Maintenance Supply Headquarters,LP. ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Store 1916 LOWE'S OF HADLEY, MA 282 RUSSELL STREET HADLEY, Massachusetts 01035 LowEss Contract Prepared for: Nate Korza 110 Prospect Ave Northampton, Massachusetts 01060 4133745579 Prepared by: Steven Lockwood (413)588-0270 steven.lockwood@lowes.com Store 1916 LOWE_S OF HADLEY_MA-Contract-975815-Page 1 of 32 LowE's MASSACHUSETTS SERVICES SOLUTIONS INSTALLED SALES CONTRACT LOWE'S AUTHORIZED REPRESENTATIVE SALES ID DATE CUSTOMER NAME Steven Lockwood 3070929 04/13/2023 Nate Korza STORE NO. STREET ADDRESS STREET ADDRESS 1916 282 RUSSELL STREET 110 Prospect Ave CITY STATE ZIP CITY STATE ZIP HADLEY MASSACHUSETTS 01035 Northampton Massachusetts 01060 TELEPHONE TELEPHONE (413)588-0270 4133745579 EMAIL EMAIL steven.lockwood@lowes.com natekl@comcast.net LOWE'S CONTRACTOR LICENSE A LOWE'S REPRESENTATIVE LICENSE A CREDIT/DEBIT CHECK LCC CARD GIFT CARD #CSL-081810;HIC#148688; 3070929 This is only a quote for the merchandise and services printed below.Lowe's does not offer services to paint,seal or stain fences. This becomes an agreement upon payment and issuance of a Lowe's receipt, upon pay-ment,the entire agreement,including the specifically completed pages of this document,the Terms and Conditions included with this document and any other addenda and attachments hereto,shall be referred to herein as this"Contract."PLEASE READ THIS ENTIRE DOCUMENT, INCLUDING THE "NOTICES,""TERMS AND CONDITIONS,"AND"ADDENDUM"CONTAINED WITHIN THIS CONTRACT ON THE FOLLOWING PAGES BEFORE SIGNING. INSTALLATION STREET ADDRESS CITY STATE ZIP 110 Prospect Ave Northampton Massachusetts 01060 MERCHANDISE AND INSTALLATION SUMMARY:(I.E. ITEM NUMBERS,COLORS, DIMENSIONS, CONSIDERATIONS): Windows Product Windows Project Installation of a single basement hopper windows. BRAND: UNITED WINDOW&DOOR PRODUCT: Series 7400 Rep HP White/White Vinyl Sizes SERIES: Series 7400 UNIT DIMS: Units 1: 33-in x 19-in OVERALL ROUGH OPENING: 33.25-in X 19.25-in GLASS: LowE-3, Single Strength(std),Argon Proposal and pricing dependent on installer second measure to ensure suitability, sizing, and estimated installation costs. United 7400 Windows(Excluding Bays/Bows)-To Be Determined- United 7400 BaylBow Window-To Be Determined- Store 1916 LOWE_S OF HADLEY_MA-Contract-975815-Page 2 of 32 Installation Process • Remove& haul away existing windows • Check existing windows for leaks and evidence of pest infestation • Install new windows&accessories, including caulk, stops, and fasteners • Follow Lead Safe Practices (if required) • Follow Health and Safety Guidelines Clean-up/Final Inspection • Complete final clean-up and haul away all job-related debris • Test product&perform complete inspection with customer • Review warranty information Project Preparation Process • Dedicated project support staff keeps you up-to-date through every pro ess • Installer conducts Pre-Installation Inspection • Provides appropriate protection to home during installation • Obtain & post any necessary permits • Perform Lead Assessment(if applicable) Work is to commence upon reasonable availability of Contractor and/or any special order or customer made Good(s)which is anticipated to be 05/16/2023.Estimated completion date is 06/13/2023. CONTRACT TOTAL $1,274.00 Payment(100%) $1,274.00 Store 1916 LOWE_S OF HADLEY_MA-Contract-975815-Page 3 of 32 NOTICES LEAD SAFE INFORMATION. Federal and applicable state laws require that You be provided with a lead hazard information pamphlet such as the Renovate Right: Important Lead Hazard Information for Families, Child Care Providers and Schools. By signing this Contract, You acknowledge having received a copy of this information pamphlet before work began informing You of the potential risk of the lead hazard exposure from renovation activity performed in Your dwelling unit or facility. A copy of the pamphlet is available at the following website: www.lowes.com/EPARRP. For more information see: https://www.epa.gov/lead/lead-renovation-repair-and-painting-program. NOTICE OF ARBITRATION AGREEMENT: This Contract provides that all claims by Customer or Lowe's will be resolved by BINDING ARBITRATION. Customer and Lowe's GIVE UP THE RIGHT TO GO TO COURT to enforce this Contract (EXCEPT for matters that may be taken to SMALL CLAIMS COURT). Lowe's and Customer's rights will be determined by a NEUTRAL ARBITRATOR and NOT a judge or jury. Lowe's and Customer are entitled to a FAIR HEARING. But the arbitration procedures are SIMPLER AND MORE LIMITED THAN RULES APPLICABLE IN COURT. Arbitrator decisions are as enforceable as any court order and are subject to VERY LIMITED REVIEW BY A COURT. FOR MORE DETAILS: Review the section titled ARBITRATION AGREEMENT, WAIVER OF JURY TRIAL AND WAIVER OF CLASS ACTION ADJUDICATION found in the Terms and Conditions of this Contract. NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M.G.L. c. 142A: LOWE'S AND OWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CONTRACT, THAT LOWE'S MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUTIVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE OWNER SHALL BE REQUIRED TO SUBMIT TO SUCH ARBITRATION AS PROVIDED IN M.G.L. c.142A. THE SIGNATURES OF THE PARTIES BELOW APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE RESOLUTION INITIATED BY LOWES, PURSUANT TO M.G.L. c. 142A. THE OWNER MAY BE PERMITTED TO INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS SECTION IS NOT SEPARATELY SIGNED BY THE PARTIES. If customer has a complaint which cannot be resolved informally, the home Improvement Contractor Law (M.G.L. c. 142A) may provide Customer with the right to request arbitration through a private arbitration program approved by the Director of the Office of Consumer Affairs and Business Regulation, as an alternative to court action. The same right is not afforded to Lowe's unless this Notice is signed and dated by Lowe's and Customer. All claims by Customer or Lowe's concerning this Contract which cannot be resolved informally, and which are not covered by M.G.L. c142A or subject to the jurisdiction of a small claims court, shall be resolved by binding arbitration gas set forth in the Terms and Conditions. By: x�tufr_n, cra-c k.urood Date: Lowe's Authorized Representative By: Date: 04/14/23 Customer PRICE CALCULATIONS. If this Contract includes Goods and related Installation Services sold by unit of measurement, such as per square foot, the Price may include more Goods than the actual measurements of Your project area. The Price includes the total amount of Goods required by Lowe's to fulfill the Contract (including surplus materials and overages) (together the "Estimated Product") and the Installation Services required based upon this total amount of Goods. For instance, a 120 square foot room may require 140 square feet of carpet to properly match the carpet seams, pattern, or unique room characteristics, and the Price would include Installation Services based upon the 140 square feet of carpet. The total amount of Estimated Product is based upon the total Goods recommended by the Installer, based on the Installer's assessment of unique characteristics of Your project. If any usable Goods are left over, Lowe's may, at its discretion, initiate a Price adjustment. Lowe's will not adjust the Contract Price for the related Installation Services. By signing this Contract, You acknowledge You are aware of Your project area measurements and the amount of Estimated Product, and that the Estimated Product may exceed Your actual project area. If Your project includes the installation of flooring materials, by signing this Contract You further acknowledge having received a completed Flooring Detail Diagram (the "Diagram") prior to execution of this Contract. Upon request, Lowe's can provide You with additional copies of the Diagram, which identifies the square footage of Your project area and the square footage of the Estimated Goods. PHOTO RELEASE. By signing this Contract, You grant to Lowe's, its representatives, and Installer the right to take and use photographs, videos, or other representations of the Premises before and after the Installation Services and all work performed at the Premises related to this Contract (the "Content"). Lowe's irrevocably keeps all rights (including the copyright); title, and interest in the Content for use in all markets and media, worldwide, in perpetuity. Lowe's can use the Content, in any form or medium, internally for any purpose (e.g., customer service, planning, and claims. NOTICE REGARDING PAYMENT SCHEDULE. If the Contract Price is$1,000 or less, payment of the Price by Customer to Lowe's is due in full upon execution of this Contract. If the Contract Price exceeds $1,000, Customer shall use the following payment schedule: (1) Deposit of $ 387.42 [enter 1/3 of the contract Price] to be paid upon signing this Contact. Any deposit collected at the time this Contract is signed will not exceed one-third(1/3)of the Contract Price; Store 1916 LOWE_S OF HADLEY_MA-Contract-975815-Page 4 of 32 Rev.03/02/2021 (2) Payment of $ 786.58 [enter 2/3 of the contract Price minus $100] to be collected upon or after the commencement of work. Customer authorizes Lowe's to charge Customer's credit card. or deposit Customer's check, for the amount of the payment indicated in this section anytime upon or after the commencement of the work; and (3) Final payment of$100 to be paid upon completion of the Installation Services to both parties' satisfaction. NOTICE OF CUSTOMER'S RIGHT TO CANCEL. If this is a "door-to-door sale" as defined by 16 C.F.R. § 429.0(a), or if this Contract is signed by Customer at a place other than the address of the seller as set forth in M.G.L. c. 93 § 48, You, the Customer, may cancel this Contract at any time prior to midnight of the third business day after the date of this transaction. See the notice of cancellation form sent as an attachment to this Contract for an explanation of this right. By executing this Contract, Customer acknowledges receipt of two (2) completed copies of the Notice of Right to Cancel form and certifies Lowe's has informed Customer orally of his or her right to cancel. NOTICE TO CUSTOMER. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Lowe's Home Centers, LLC EXECUTION DATE: 04/13/23 LOWE'S AUTHORIZED REPRESENTATIVE SIGNATURE OWNER'S SIGNATURE CO-OWNER SIGNATURE )Lult,n. orvc k.ur ci F-- Customer acknowledges receipt of a true copy of this contract which was completely filled in prior to Customer's execution hereof. Store 1916 LOWE_S OF HADLEY_MA-Contract-975815-Page 5 of 32 Rev.03/02/2021 Lowe's Custom Order Quote LOWE'S Quote# 786332483 Quote Name: korza hopper window Date Printed: 6/26/2023 Customer: Nate Korza Store: (1916)LOWE'S OF HADLEY,MA hem Total: 1 PreSavings Total: $269.51 Email: natekl@comcast.net Associate: STEVEN LOCKWOOD(3070929) Freight Total: $0.00 Address: 110 PROSPECT AVE Address: 282 RUSSELL STREET Labor Total: $0.00 NORTHAMPTON,MA 01060 HADLEY,MA 01035-0000 Pre-Tax Total: $229.08 Phone: (413)374-5579 Phone: (413)588-0270 Savings Total: ($40.43) United Window&Door I Series 7400 T T Replacement Basement Hopper • 31.5 x 16.75 I Ext=White I Int=White / LowE-2 I Argon I Single Strength i1 315' Room Location:None Assigned � — --� r- RO-31 75" Line# Item Summary Production Time Was Price Now Price Quantity Total Savings Pre-Tax Total 100-1 United Window&Door I Series 7400 Replacement 21 $269.51 $229.08 1 ($40.43) $229.08 Basement Hopper 31.5 x 16.75 Valid thru:07/07/2023 Begin Line 100 Description —Line 100-1---- United Window&Door I Series 7400 Glass Type=LowE-2 'Delivery Method=In-Store Pick-Up Replacement Basement Hopper Gas Fill=Argon Model Number=7469BA001 OverallSize=31.5 x 16.75 Glass Strength=Single Strength Remake=No Operation/Venting=Operating Tempered=No `Room Location= Unit Type=Complete Glass Tint=None Satisfied Energy Star Zones=North Central Exterior Frame Color=White Overall Frame Width=31.5 Interior Frame Color=White Overall Frame Height=16.75 Window Locks=Single Lock Foam Wrap=No End Line 100 Description Accepted by: Date: 6/26/2023 Pre-Tax Total ' 5229.08 This quote is an estimate only and valid for 30 days on all regularly priced items.For promotional items please refer to the dates listed above. This estimate does not include tax or delivery charges. Estimated arrival will be determined at the time of purchase.All of the above quantities,dimensions,specifications and accessories have been verified and accepted by the customer. ****Special order configured products returned or canceled after 72 hours from purchase are subject to a 20%restocking fee.**** Page 1 Of 1